DE102021100091A1 - System for the provision of gases for ventilation and oxygenation with the supply of inhalative substances - Google Patents

Abstract

The present invention relates to a system (1000) for supplying substances to a patient (30) with ventilation and oxygenation. The system (1000) has at least one ventilation system (1), a system for inhalative sedation (17) with a metering system (7), an oxygenation system (2), a breathing gas metering path (3), a flushing gas metering path (4), a breathing gas connection system (5), a connection element (25) close to the patient, an oxygenation connection system (6) and a switching unit (8). The amount of an inhalative substance dosed into a gas mixture is formed between the connecting element (25) close to the patient and the oxygenation system (2). At least one control unit (9, 10, 11, 12) is designed to control the switchover unit (8) and / or the system (1000).

Description

The present invention relates to a system for providing gases for ventilation and oxygenation with the supply of inhalative substances. A combined system with a device for providing respiratory gases, gases or gas mixtures for ventilation and oxygenation of a patient with gases or gas mixtures and with a device for extracorporeal membrane oxygenation of a patient is described. The system according to the invention with the devices for ventilation and extracorporeal membrane oxygenation enables inhalation substances or anesthetics to be supplied by means of the gas or gas mixture made available to the patient. The substances are, for example, and preferably gases dissolved in the gas phase or vapor phase, such as anesthetics, anesthetic gases, narcotics or anesthetics, medicamentous substances dissolved in the gas phase or vapor phase or drugs which are suitable for inhalation administration in the breathing gas. In the context of the present invention, the term “breathing gas” is to be understood as a generic term for quantities of gas supplied to the patient or carried away by the patient, so that inhaled gas, exhaled gas, breathing gases, inhaled gases, exhaled gases as well as breathing gas, breathing gases are to be understood.

The use of conventional ventilation in intensive care units and while an operation is being carried out often leads to undesirable side effects, such as baro / volutrauma and aspiration, which can partially damage the lungs and lead to complications such as pneumonia or sepsis. To avoid further damage and as therapy for damaged heart or lungs, there are approaches to oxygenation and circulatory support, such as veno-venous extracorporeal membrane oxygenation (v.v. ECMO), pumpless extracorporeal lung support for carbon dioxide elimination (pECLA) and veno-arterial extracorporeal membrane oxygenation ().

Ventilation and anesthesia devices are known from the prior art, which can be used for ventilation in an intensive care unit (ICU) or for performing surgical interventions in operating theaters (OR).

the US 2016067434 AA shows a ventilator for ventilating a patient for use in an intensive care unit. The purpose of the ventilator shown is to avoid complications while performing ventilation.

the US 4148312 A shows a combination of an anesthesia machine and a ventilator. For ventilation to be carried out during a surgical procedure, unconsciousness, insensitivity to pain and relaxation of the patient's muscles are essential. For this purpose, different volatile anesthetics (halothane, isoflurane, desflurane, sevoflurane, ether) as well as nitrous oxide with different hypnotic, analgesic and muscle relaxing properties in combination with air and oxygen are administered to the patient by inhalation with the help of the anesthesia device, for example by means of an endotracheal tube. In addition, medication is usually entered into the bloodstream in an invasive manner. The volatile anesthetics or anesthetic can be metered into the breathing gas or into the breathing gas mixture, for example, by means of evaporation with an anesthetic vaporizer - also referred to as an anesthetic vaporizer.

the US 2016008567 AA shows a system for dosing anesthetic or volatile anesthetic.

the WO 09033462 A1 shows an anesthetic vaporizer with a storage container and a conveying and metering device, a vapor pressure of the anesthetic being generated by increased temperature and saturated anesthetic vapor being generated.

So-called heart-lung machines (HLM) are used in particular when performing operations on the heart. These heart-lung machines (HLM) take over the function of the heart and lungs for the duration of the operation on the heart, that is, the supply of oxygen to the patient's bloodstream and the removal of carbon dioxide from the patient's bloodstream as well as the blood flow into the patient Blood vessels. For example the GB 2568813 A1 a heart-lung machine for extracorporeal gas exchange and oxygenation.

From the WO 2009033462 A1 a device for providing anesthetic gas is known. The device enables saturated anesthetic vapor to be provided and supplied to a patient without the need for external fresh gas or transport gas.

the US 2020038564 AA shows a blood pump which is suitable for extracorporeal transport of blood.

the US 9901885 BB shows a membrane which is designed and provided for a blood-to-gas and gas-to-blood exchange.

the US 6174728 BA, US 4279775 A and US 2003064525 AA show devices for a determination of components and blood gases in the blood of living things.

Knowing the above-mentioned prior art, the present invention has the task of providing a system which enables substances to be fed into the breathing circuit in gaseous form and substances outside the body to be fed into the bloodstream of a patient in gaseous form.

Another object of the present invention is to provide a device which enables a distribution and / or division of subsets of breathing gas into the breathing circuit and the blood circuit of a patient.

The above objects are achieved by the independent patent claims 1 and 13.

The object for a system for a gaseous supply of substances is achieved by a system for providing gases for ventilation and oxygenation of a patient with a supply of substances having the features of claim 1.

The object for a device for distributing and / or dividing subsets of breathing gas into the breathing circuit and the blood circuit of a patient is achieved by a gas distribution unit with the features of claim 13.

Advantageous embodiments of the invention emerge from the subclaims and are explained in more detail in the following description with partial reference to the figures.

A first inventive aspect is formed by a system for supplying substances with a gaseous supply both into the breathing circuit and into the blood circuit of a patient. The system according to the invention for a supply of substances enables a gaseous supply of substances into the breathing circuit and a gaseous supply of the substances outside the body into the blood circulation of a patient. It thus enables, for example for use in a clinical setting in an intensive care unit (ICU), a simultaneous and / or parallel coordinated operation with the supply of substances for inhalative sedation in the blood circulation as well as in the breathing circuit. The substances can be supplied to inhalative sedation by means of simultaneous and / or parallel coordinated operation via an airway access of the patient, as well as via a gas / blood exchange system (membrane oxygenation, ECMO, oxygenator, oxygenation system). With the system according to the invention, both an administration of substances for inhalative sedation via the lungs into the cardiovascular system of the patient and an administration of these substances via the gas / blood exchange system into the blood circulation of the patient (extracorporeal circulation) can be made possible .

• - ein Beatmungsgerät mit einem Beatmungssystem (BS) und
  • - mit einem Atemgas-Verbindungssystem,
  • - mit einem patientennahen Verbindungselement (Y-Stück)
• - ein Oxygenierungssystem (OS) mit einem Oxygenierungs-Verbindungssystem,
• - ein System zur inhalativen Sedation (SIS) mit einem Dosiersystem (DS),
  • - mit einem Gasentnahmeanschluss für Einatemgas,
  • - mit einer Reflexionseinheit (CR),
  • - mit einem Gasrückführungsanschluss für Einatemgas,
• - eine Umschalteinheit,
• - einen Atemgas-Dosierungspfad,
• - einen Spülgas-Dosierungspfad und
• - mindestens eine Kontrolleinheit

auf.A system according to the invention has:

• - a ventilator with a ventilation system (BS) and
  • - with a breathing gas connection system,
  • - with a connection element close to the patient (Y-piece)
• - an oxygenation system (OS) with an oxygenation connection system,
• - a system for inhalative sedation (SIS) with a dosing system (DS),
  • - with a gas extraction connection for inhalation gas,
  • - with a reflection unit (CR),
  • - with a gas return connection for inhalation gas,
• - a switching unit,
• - a breathing gas dosing path,
• - a purge gas metering path and
• - at least one control unit

on.

The ventilation system is designed to provide breathing gases to the patient. The breathing gas connection system is designed for a gas-carrying connection to a supply with supply and continuation of quantities of breathing gases to the patient. The system for inhalative sedation (SIS) is formed by the dosing system, the gas extraction connection for extracting partial amounts of breathing gas from the inhaled gas, the reflection unit and the gas return connection for returning the partial amounts of breathing gas from the dosing system to the switching unit.

The system for inhalative sedation (SIS) is designed with the dosing system to dose inhaled substances. The inhalation sedation system (SIS) is supplied with partial amounts of breathing gas from the ventilator or ventilation system.

The switching unit is one of the inhalative sedation (SIS) system Inhalative substances enriched partial amount of breathing gas supplied and provided by means of the gas extraction connection and the breathing gas connection system.

According to the invention, the switchover unit enables gas quantities enriched with inhalative substances to be split up and / or distributed into the breathing gas metering path and the flushing gas metering path.

A partial amount of breathing gas enriched with inhalative substances is supplied and made available to the patient's airways by the switching unit by means of the breathing gas metering path and the connecting element close to the patient.

A partial amount of breathing gas enriched with inhalative substances is fed from the switching unit to the oxygenation system by means of the flushing gas metering path and made available.

By means of the breathing gas connection system, a partial amount of breathing gas enriched with inhalative substances is supplied to and made available to the patient by the switching unit via the connection element close to the patient.

By means of the breathing gas connection system, a further partial amount of breathing gas, which is not enriched with inhalative substances, is supplied to the patient via the connection element near the patient and made available by the breathing system.

By means of a flushing gas flowing in the flushing gas metering path, amounts of blood enriched with inhalative substances are supplied to the patient from the oxygenation system via the oxygenation connection system. For this purpose, a gas for blood exchange and a gas for blood exchange take place in the oxygenation system, with _{gas quantities provided and enriched with oxygen O 2} and the inhaled substances from the oxygenation connection system passing through a membrane into the patient's bloodstream and at the same time quantities of carbon dioxide CO ₂ , produced in the patient's metabolism, pass from the patient's bloodstream into the purge gas dosing path. These processes of gas-to-blood and gas-to-blood exchange are known as oxygenation and decarboxylation. The oxygenation connection system is designed for a fluidic connection with the blood circulation for the supply and removal of quantities of blood from the patient. The oxygen-enriched blood provided by the oxygenation system is invasively supplied to the patient as a fresh and oxygen-enriched amount of blood with a supply line by means of the oxygenation connection system.

Away from the patient, an amount of blood enriched with carbon dioxide is returned from the patient to the oxygenation system by means of the oxygenation connection system. The oxygenation connection system thus enables the patient to be supplied with volatile substances and _{amounts of blood enriched with oxygen (O 2} ) and a continuation of amounts of blood enriched with carbon dioxide (CO ₂ ).

In the usual configuration, the ventilation system is part of a ventilation device. Ventilation systems for ventilators usually have suitable means for providing, supplying and conveying breathing gases and substances to and from the patient, such as means for gas mixing and gas delivery, for example at least one gas delivery unit (blower, blower, piston drive, valve arrangement), as well as means for gas routing, such as breathing gas connection system, for example in the form of ventilation hoses and a connection element - the so-called Y-piece - to connect the ventilation hoses to an endotracheal tube, a breathing mask or a tracheostoma. In addition, connecting elements are also known which include an exhalation valve close to the patient. In addition to the ventilation system, ventilation devices also have elements - in particular sensors - for the measurement of given and / or set pressures, flow rates and other operating parameters of mechanical ventilation with the supply of gases and gas mixtures. For mechanical ventilation, at least the following parameters such as inspiratory and expiratory ventilation pressures, ventilation frequency, inspiration to expiration ratio, pressure upper and lower limits, flow rate upper and lower limits, volume upper and lower limits and gas concentrations are set and / or monitored. In the context of the present invention, the ventilator and ventilation system support the system for supplying substances in the task and function of ensuring ventilation of the lungs, ie ensuring that the lungs or individual areas of the lungs (alveoli) collapse. In addition, the ventilation system supports the patient with the O ₂ / CO ₂ gas exchange in the lungs. The system for supplying substances has suitable elements for conveying, supplying and / or returning quantities of breathing gases. The breathing gas provided by the breathing system is supplied to the patient as fresh breathing gas with an inspiratory breathing tube by means of an inspiratory path of the breathing gas connection system. The one exhaled by the patient Breathing gas or breathing gas mixture is returned or continued by means of the breathing gas connection system.

The inspiratory path and the expiratory path of the breathing gas connection system are usually brought together near the patient with the aid of a near-patient connection element, a so-called Y-piece, at the patient's location. The air exhaled by the patient is released from the patient via an expiratory path of the breathing gas connection system with the help of an exhalation valve, the so-called exhalation valve, often referred to as an EX valve, into the environment or into a suitable system for absorbing used gas quantities. Depending on the design of the ventilator, the exhalation valve can be arranged in the ventilator itself so that exhaled breathing gases can flow out to the environment by means of a tracheostoma, endotracheal tube or nasal mask via the connecting element (Y-piece) and an expiratory ventilation hose and the expiration valve. In an alternative embodiment, the expiration valve can be arranged outside the ventilator close to the patient, so that exhaled respiratory gases can flow directly to the environment via the tracheostoma, endotracheal tube or nasal mask via the expiration valve. In such an embodiment, no return of breathing gases with an expiratory breathing tube into the breathing apparatus is provided via the breathing gas connection system.

The system for inhalative sedation (SIS) enables the provision of inhalative substances, for example substances with hypnotic (narcotics), analgesic or muscle relaxing properties or effects. The inhalative sedation system (SIS) enables the inhalation substances to be metered or added via the switching unit to the ventilation system and / or to the oxygenation system and in this way places gas quantities enriched with the inhalation substances in the breathing circuit and in the lungs of the patient and / or into the patient's bloodstream via the oxygenation system.

The connection between the switchover unit and the connecting element close to the patient with the supply of the partial amount of breathing gas enriched with the inhaled substances to the patient takes place with the aid of the breathing gas metering path.

The connection between the switchover unit and the oxygenation system with the supply of the partial amount of breathing gas enriched with the inhalative substances to the oxygenation system takes place with the aid of the flushing gas metering path.

According to the invention, the at least one control unit is designed to monitor the switchover unit. The control includes coordinating the division and / or distribution of gas quantities provided and / or supplied by the dosing system between the dosing paths, that is to say between the flushing gas dosing path and the breathing gas dosing path. To a certain extent, the control unit carries out a gas or gas mixture management between the two metering paths. The gas quantities provided and / or supplied by the inhalative sedation system (SIS) and / or the metering system are enriched or saturated with quantities of substances, quantities of volatile substances or quantities of volatile anesthetics. With the control and / or coordination of the gas or gas mixture management, the at least one control unit provides suitable specifications as to which amounts of substances, volatile substances or volatile anesthetics are then added to the breathing gas via the breathing gas connection system with the supplied amounts of breathing gas The breathing circuit and the lungs of the patient, or to the oxygenation system and thus from the oxygenation system via the oxygenation connection system, are then fed into the patient's bloodstream with supplied or exchanged amounts of blood.

By controlling and coordinating the switchover unit by means of the at least one control unit, in particular the control unit in the switchover unit, a balance can be set when inhaling substances are supplied, for example between inhalation anesthesia and extracorporeal anesthesia, or this balance can also be canceled during therapy medical considerations. The at least one control unit can thus specify a user with regard to setting or changing a therapeutic focus with regard to the balance between extracorporeal sedation by means of the oxygenation system or inhalative sedation by means of the inhalative sedation system (SIS) during operation of the system according to the invention, which has a gaseous supply of Substances in the breathing circuit and a gaseous supply of the substances outside the body in the bloodstream of a patient allows to put into practice.

The system for inhalative sedation (SIS) has, for example, a gas withdrawal connection for inhalation gas for withdrawing a partial amount of inhalation gas from the inspiratory path of the breathing gas connection system as a suitable element for supplying amounts of breathing gases to the dosing system.

For example, the inhalative sedation (SIS) system has a Gas return connection for inhaled gas for returning partial amounts of inhaled gas from the switching unit back into the inspiratory path of the breathing gas connection system and / or to the connection element (Y-piece) close to the patient as a suitable element for supplying amounts of breathing gases to the patient. The system for inhalative sedation (SIS) has suitable elements for storing and / or providing quantities of exhaled breathing gases or breathing gas mixtures from the patient. The system for inhalative sedation (SIS) has, for example, a reflection unit or an anesthetic gas reflector as a suitable element. During exhalation, most of the anesthetic gas is stored or buffered in the reflection unit or in the reflector and reused during the subsequent inhalation. The reflector can be designed, for example, as a carbon reflector, which is designed to store or buffer the inhaled substances for a period of several days. An exemplary structure of a reflection unit has a chamber with a reflection means, for example a granulate of a suitably impregnated activated carbon, in the gas flow for the breathing gas. The activated charcoal enables the inhalation substances to be absorbed, buffered and briefly bound from the exhaled gas of the patient while the patient exhales and enables the inhalation substances to be released with the subsequent inhalation into the inhalation gas back into the breathing gas connection system with supply to the patient.

Such a reflection unit is arranged in or on the breathing gas connection system, preferably on the connection element (Y-piece) or close to the connection element (Y-piece). Alternatively, the reflection unit can be designed as part of the connection element (Y-piece) of the breathing gas connection system. Alternatively, the connection element (Y-piece) can be designed as part of the reflection unit in the breathing gas connection system. The reflection unit has elements for filtering and / or buffering gas components and / or substances, in particular inhalative and / or volatile substances, in the breathing gas. The reflection unit is sometimes also referred to as a reflector, gas reflector, or anesthetic gas reflector or anesthetic gas reflector.

In a preferred embodiment of the system, the metering system can be designed for metering inhalation and / or volatile substances or volatile anesthetics.

In a preferred embodiment, another chamber can be arranged in the gas flow in the reflection unit, which absorbs moisture present in the exhaled gas during exhalation, briefly buffers and binds it and then enables humidified inhalation gas to be supplied to the patient during the subsequent inhalation. Such a further chamber arranged in the gas flow thus has the function of a filter element in the form of a so-called HME filter (Heat and Moisture Exchanging).

In a further preferred embodiment, a further filter element can be arranged in or on the reflection unit in the further chamber or in a further additional chamber, which is designed for filtering with retention of germs, viruses or bacteria in the breathing gas.

The gas return connection can be designed as a component of the connection element close to the patient. The gas return connection can be designed as a component of the reflection unit.

In a preferred embodiment, the gas return connection, the reflection unit and the connection element close to the patient can be designed as one structural unit. In a preferred embodiment, the gas return connection, the connection element close to the patient and the reflection unit can be designed as one structural unit in combination with the further filter element and / or the HME filter. The gas extraction connection as well as the gas return connection for inhaled gas can in a preferred embodiment in a common structural unit with the reflection unit and / or the breathing gas connection system and / or the connection element near the patient (Y-piece) and / or the further filter element and / or the HME -Filter be designed. The gas extraction connection as well as the gas return connection for inhaled gas can in a preferred embodiment in a common structural unit with the reflection unit with an expiration valve close to the patient and / or the breathing gas connection system and / or the connection element close to the patient (Y-piece) and / or the further filter element and / or the HME filter.

The system for inhalative sedation (SIS) is provided with a metering system with appropriately designed elements for metering inhalative substances. Suitable trained elements to one Dosing of inhalative substances are, for example, valves or valve arrangements in the form of controlled, ie for example electrically or electronically controlled or regulated valves for dosing inhaled substances into a gas mixture. These include, for example, magnetic or electromagnetic control valves, as well as piezo valves or piezo actuators. Elements suitable for metering inhalation substances are, for example, devices for evaporation or evaporation of inhalation substances. Suitable devices for the evaporation or evaporation of inhalative, preferably volatile substances are formed, for example, by anesthetic vaporizers. Such anesthetic gas vaporizers, mostly referred to as vapors, enable the gas flow to be enriched with volatile substances suitable for inhalative sedation or sedation of a living being, for example an enrichment in an adjustable concentration of volatile anesthetics, e.g. desflurane, halothane, isoflurane, sevoflurane, ether. Vapors work according to the dosing principle of changing the ratios of flow rates between a main flow and a secondary flow. Main and secondary flow are brought together at the outlet of the vapors. In the secondary flow, the gas supplied is saturated with the volatile substances; the degree of metering - and thus also the concentration - of the substances at the outlet of the vaporizer can be set by adjusting or setting the flow rate ratio between the main and secondary flow. In the metering system, the supplied gas flow is thus enriched with substances suitable for inhalative sedation or sedation of a living being.

A suitable option for dosing inhalative substances by the dosing system in the inhalative sedation system (SIS) is given, for example, by using the gas extraction connection on the breathing gas connection system, on the connection element close to the patient, on the reflection unit or on the ventilation system, a partial amount of inhaled gas from the total amount branch off and then dose certain amounts of inhalative substances into this subset in the metering system. Such a metering can be done, for example, by a metering valve which metered the inhaled substances into the branched off partial quantity of the inhaled gas in a pulsed manner.

Subsequently, the branched off and now enriched with inhalative substances partial quantities of the inhalation gas is introduced back into the gas flow in the breathing gas connection system via the gas recirculation connection, preferably or for example on the reflector or on the connection element (Y-piece) and fed to the patient. The volatile substances are fed in as a metering into the inhalation gas. From the ventilator or the ventilation system, via an inspiratory path of the breathing gas connection system, a gas mixture of air and oxygen as breathing gas is supplied to the patient for carrying out ventilation therapy in terms of pressure, pressure over time, flow rates, and volumes. Partial quantities of this inhaled gas are conveyed to the dosing system by means of the gas extraction connection via a connecting element, which is usually designed as a hose line. In the metering system, the inhalative or volatile substances are metered in for further use in the therapy of the patient via the lungs and / or via the blood circulation. The inhalative substances are supplied to the breathing gas or the breathing gas by means of the dosing system for inhalative sedation, for example in the form of volatile anesthetics or in the form of other substances, and reach the switching unit via a connecting element, which is usually also designed as a hose line.

In an alternative embodiment, the metering of the inhaled substances by the metering system can be done by controlling a variable branched off partial amount from the total amount of inhaled gas, preferably in combination with a constant metering by the metering valve or a variable metering by a control valve, for example a proportional valve . If the inhalative substances are in liquid form, the inhalation sedation system (SIS) has a device for heating, for example a heater, which enables the inhalation substances to be converted from the liquid phase into a gaseous phase, so that the control valves or metering valves, inhalation substances can be metered into the inhalation gas in gaseous form.

In a preferred embodiment, the control unit can be designed, the metering of the inhaled substances, configured as a pulsed metering or configured as a constant or variable metering and / or the control of the amount of the branched off partial amount by the dosing system based on the connection element (Y- Piece), on the breathing gas connection system, or on the reflection unit of certain concentrations of the inhaled substances.

To determine the concentrations of the inhaled substances in the inhaled gas, for example, a measuring system for a process gas analysis (PGA) can be used to determine a gas concentration, in particular a gas concentration of an inhaled substance or an anesthetic gas concentration in the exhaled gas, which is used as a separate measuring system in the system The supply of substances can be arranged, can be assigned to the system for supplying substances, or it can be configured as an element of the system for inhalative sedation (SIS) or as an element of the dosing system. Such a measuring system (PGA) is designed on the basis of a, with a suction conveying and to carry out an analysis of the breathing gas with regard to concentrations of inhalative substances, in particular anesthetic concentrations or nitrous oxide (nitrous oxide, N ₂ O), as well as carbon dioxide CO ₂ or oxygen (O ₂ ), by means of a measuring gas line provided by the amount of breathing gas from the breathing gas connection system or from the connection element . In this case, the inhalative substances are preferably metered into the inhaled gas by the dosing system during the inhalation phases, while in the exhalation phases in the exhaled gas, the concentration determinations with regard to the concentrations of inhalative, inhalative, volatile substances, in particular anesthetic concentrations or nitrous oxide (nitrous oxide, N ₂ O), such as carbon dioxide CO ₂ or oxygen (O ₂ ) also take place. In particular, there are concentrations at the end of the exhalation phases, so-called end-tidal concentrations of carbon dioxide (etCO ₂ ) of at least one inhalative substance or at least one anesthetic agent (etVA) for the control of ventilation and / or the dosage of the inhaled substances in the system for a supply of substances of interest.

In a preferred embodiment, the metering system is designed to meter the inhalation substances on the basis of an end-tidal concentration of at least one inhalation substance or at least one anesthetic.

In a preferred embodiment, the metering system is designed to carry out the pulsed metering in of the inhalative substances through the metering valve based on or as a function of the end-tidal concentration of at least one inhalative substance or at least one anesthetic.

In a preferred embodiment, the metering system is designed to control a variable branched off partial amount from the total amount of inhaled gas through the control valve on the basis of or as a function of the end-tidal concentration of an anesthetic.

The metering system is designed for metering volatile or inhaled substances and / or for metering volatile anesthetics. On the one hand, this offers the advantage that the system for supplying substances by means of the ventilation system and the system for inhalative sedation enables the administration of volatile agents, so that, for example, inhalation anesthesia can be carried out with it. However, the ventilation system and the inhalation sedation system can also be used to administer amounts of volatile medicaments by inhalation. The metering system is thus designed for metering volatile substances, for example drugs. The following list includes some examples of possibilities for - possibly also gas phase or vapor phase soluble medicinal substances - such as substances or agents for influencing the cardiovascular system, e.g. with an effect on blood pressure and heart rate, drugs for influencing the metabolism, the fluid balance or the hormonal situation of the patient, as well as medicaments which, with regard to function and / or healing, or recovery or for pain therapy as therapeutic measures for organs, e.g. lungs, heart, kidneys, pancreas, liver, stomach, intestines, sexual organs, sensory organs, brain , Nervous system, bronchial tract, skeleton, skin and muscles, thyroid gland, gall bladder, inhalatively in the gas phase or vapor phase.

In a special embodiment, the dosing system can also be designed as a component of the inhalative sedation system (SIS); Be formed connection system.

There is the advantage that the system for supplying substances by means of the oxygenation system enables the administration of volatile agents, for example volatile anesthetics or volatile drugs with hypnotic (narcotics), analgesic or muscle-relaxing properties into the bloodstream .

According to the invention, the switchover unit enables a switchover, division or distribution of gas quantities and / or inhalative substances for sedation, such as volatile anesthetics or medicaments, for example. According to the invention, the switching unit is used to switch, split or distribute gas quantities of the gas between the breathing gas connection system and the connection element (Y-piece) with reflection unit on the one hand and the oxygenation system on the other. With the switchover, division or distribution of gas quantities, there is also an indirect supply with division or distribution of the inhalative or volatile substances, anesthetics or other substances from the dosing system to the breathing gas connection system with the connection element close to the patient and / or to the oxygenation system.
Suitable means of the switchover unit for switchover and distribution are, for example, valves or arrangements of valves, 3/2-way valves or a combination of two in parallel in the gas flow arranged 2/2-way valves with corresponding status control for distribution and division into partial quantities from the dosing system by means of the breathing gas dosing path to the breathing system, or by means of the purging gas dosing path to the oxygenation system.
The switching unit is designed to switch between the two dosing paths and, in cooperation with the two dosing paths, to distribute and split the enriched gas quantities of breathing gas to the oxygenation system and to the connection element near the patient. The inhalative or volatile substances are fed to the breathing gas by means of the dosing system and the inhalative sedation system (SIS) of the switching unit and arrive from the switching unit either via the gas recirculation connection and via the breathing gas dosing path and the breathing gas connection system, mostly via the connection element close to the patient (Y-piece) into the breathing gas and by means of the endotracheal tube, tracheostoma, or nasal mask into the bronchial tract and the lungs of the patient, or from the switching unit via the purge gas dosing path to the oxygenation system and then from the oxygenation system by means of the oxygenation connection system into the patient's bloodstream .
In configurations of the system for supplying substances in the field of intensive care medicine or emergency medicine, the switching unit in the gas flow is connected downstream of the dosing system. In a special embodiment, the switchover unit can also be designed as a component of the inhalative sedation (SIS) system; in a particular embodiment, the switchover unit can also be designed as a component of the ventilator.

In a particular embodiment, the switchover unit can be designed as a component part of the breathing gas connection system or as a component part of the oxygenation connection system. In a particular embodiment, the switchover unit can be designed as a component of the breathing gas metering path or as a component of the flushing gas metering path. In a special embodiment, the switchover unit can also be designed as a component of the metering system.

The oxygenation system is designed to provide oxygen and eliminate carbon dioxide into a bloodstream to the patient. The oxygenation system has a membrane for a gas / blood exchange. With the aid of this membrane, a quantity of oxygen is fed into the blood quantity of the patient's bloodstream by means of a flushing gas and a quantity of carbon dioxide is removed from the patient's bloodstream. The purging gas is made available to the oxygenation system by the switching unit with the aid of the purging gas connection path.

In a preferred embodiment, the amount of blood can be transported to and from the patient by means of blood conveying means, for example a blood conveying unit (pump). Such a blood delivery unit (pump) is preferably arranged in or on the oxygenation connection system or in or on the oxygenation system and is used to transport the amount of blood to and from the patient. Such a pump can be connected veno-venous (VV-ECMO) or arterio-venous (VA-ECMO) by means of suitable infusion cannulas and tubes with typical external diameters in the range from approximately 3.0 mm to 12.0 mm. The pump conveys blood flow rates in the range from 0.2 L / min to 10 L / min to the oxygenation system and back again. Here, too, the patient's blood circulation is accessed, for example, via the femoral artery and the femoral vein, or alternatively via the femoral artery and the external jugular vein. The blood delivery unit enables, in particular in one embodiment of a blood delivery unit with adjustable delivery rate, to carry out the extracorporeal blood gas exchange individually tailored to the situation and the patient with regard to the removal of carbon dioxide and the supply of oxygen.

The transport of the amount of blood to and from the patient can take place in a special embodiment of the oxygenation system without an external blood supply, for example by a pump. In such a special embodiment, the amount of blood is transported to and from the patient by the pumping capacity of the patient's heart. This is referred to as pumpless extracorporeal membrane oxygenation or pumpless extracorporeal lung support (pECLA). The pump-free extracorporeal membrane oxygenation is coupled to the artery venous, for example by means of the femoral artery and the femoral vein with the help of suitable infusion cannulas and tubes with typical internal diameters in the range of approximately 3 mm to 7 mm, so that the heart outside the body typically has a blood flow rate in Pumps range from 2 L / min to 2.5 L / min to the oxygenation system and back again.

Preferred embodiments of the system according to the invention for supplying substances can have configurations of the control unit as a central control system or a central control unit. These further preferred embodiments offer the advantage that a large amount of information is centralized processed, can be related to each other and then the monitoring, control and / or regulation of the ventilation, the extracorporeal blood gas exchange or the implementation of the therapy can be coordinated and controlled centrally. Changes in the operating mode or therapy can advantageously be coordinated centrally, such as setting a balance between inhalation anesthesia and extracorporeal anesthesia, or also the removal of this balance during therapy from a medical point of view with setting a new focus of therapy to, for example, essentially extracorporeal delivery of drugs or sedative substances narcosis or inhalative delivery of drugs or sedative substances.
However, preferred embodiments of the system according to the invention for supplying substances can also be designed with a large number of individual control units which, in combination and interaction with one another, then form a common control of the system.
The control of the system can nevertheless be designed as a so-called “master-slave” arrangement by means of a large number of control units (slaves) in cooperation with a central control unit (master). Control units can be arranged in the ventilation system, in the inhalative sedation system (SIS), the dosing system, the oxygenation system, the switchover unit or also in an external module.

These preferred embodiments of the system offer the advantages that information from different systems can be combined with one another, this also enables combinations of devices from different manufacturers and enables existing devices to be expanded with additional devices or modules. Coordination and cooperation with one another is made possible by coordinated protocols in data exchange, for example in a data network (LAN, WLAN).

In further preferred embodiments of the system, a single control unit at least in the switchover unit and / or a single control unit in the dosing system and / or in the ventilation system and / or an external control unit can be arranged in the decentralized control system. One or more of the individual control units and / or the external control unit can be designed to control the switchover unit and / or the metering system. The control can include a coordination of the division and / or distribution of gas quantities provided and / or supplied by the dosing system between the dosing paths, that is, between the flushing gas dosing path and the breathing gas dosing path by means of the switchover unit. In addition, the control can also include the type and manner of dosing by means of the dosing unit, as well as a combined control of the switching unit and the dosing system that is tailored to the operation of the system for providing gas or gas mixtures with the supply of substances, for example for performing inhalation anesthesia with combined supply of anesthetic gases into the breathing circuit and into the bloodstream of a patient.

These further preferred embodiments offer advantages in the coordination and control of the system with regard to the computing power, memory requirements and response time requirements given for the individual functions.

Refinements are made possible to the effect that, for example, control processes with high temporal performance requirements for the dosing can be carried out directly in a control unit in the dosing system, but, for example, a switchover of the distribution of the gas quantities in the oxygenation system and the system for inhalative sedation with moderate temporal performance requirements can be done by means of the external control unit. Changes to this distribution of quantities can also take place, for example, using a wirelessly connected mobile terminal device as a special design variant of an external control unit, such as a tablet computer, smartphone, mobile phone.

In a further preferred embodiment of the system for supplying substances, at least one of the control units can take into account data provided by the inhalative sedation system (SIS), the ventilation system (BS) and / or the oxygenation system (OS) when controlling the switching unit. This further preferred embodiment offers the advantage that, for example, the information about changes made by the user to the type of ventilation on the ventilator or recently activated or initiated can be taken into account when checking the switchover unit in such a way that the changes initiated can be implemented it is waited before a change of state is carried out by the switchover unit. The same applies to initiated changes to the oxygenation system with regard to the control of the switchover unit. Furthermore, possible alarms from the ventilator, ventilation system (BS), inhalative sedation system (SIS) and oxygenation system can be taken into account for the control of the switchover unit, for example in such a way that only certain changes to the operating status of the switchover unit are possible when there are alarms.

The control unit or the individual control units are designed to control the switching unit as well as the metering system. The control unit can also be designed to control the ventilator, the ventilation system, the inhalative sedation system, the dosing system and the oxygenation system. The control unit can be arranged as a functional element or control module in or on the ventilator, the ventilation system, the system for inhalative sedation, the dosing system, the system for inhalative sedation, the oxygenation system or the ventilator, the ventilation system, the system for inhalative sedation, be assigned to the dosing system, the oxygenation system.

The control unit as well as the individual control units, as functional elements, provide a wide variety of functions for operating the system according to the invention. A data memory (RAM, ROM), which is designed to store a program code, is usually provided in the control unit. The execution of the program code is coordinated by a microcontroller or other configuration of computing elements (FPGA, ASIC, µP, µC, GAL) arranged as an essential element in the control unit. The control unit and / or the individual control units are designed, prepared and provided to coordinate the operation of the system and / or the interaction of the ventilation system, system for inhalative sedation, dosing system, oxygenation system and switching unit and other components and systems and the comparison operations required in the process , Arithmetic operations, storage and data organization of the amounts of data, control of actuators and sensors, recording of measured values from measuring probes and sensors, data and information processing, as well as information and data provision on components inside the system and outside the system.

According to the invention, according to the first inventive aspect, the switching unit is used to switch, split or distribute gas quantities between the breathing gas connection system, in particular the connection element (Y-piece) close to the patient and the oxygenation system. With the switchover, division or distribution of gas quantities, the switchover unit enables the substances provided to be conducted into the patient's lungs for inhalative sedation with the breathing gas and also into the patient's bloodstream via the oxygenation system. This offers advantages, for example, if inhalative therapy of quantities of volatile, inhaled drugs or substances by means of the ventilator or by means of the ventilation system in combination with the system for inhalative sedation and, if necessary, at the same time or instead also by means of the oxygenation system.

Another inventive aspect is formed by a gas distribution unit according to the invention as a structural unit on the connecting element close to the patient. This results in a space-saving, compact arrangement with a low volume close to the airway access to the patient. A gas distribution unit according to the invention forms a device for distributing and / or dividing subsets of breathing gas into the breathing circuit and the blood circuit of a patient and is formed by a common structural unit with at least one switching unit, a breathing gas metering path, a connection element close to the patient, a gas extraction connection for extraction of partial amounts of breathing gas from the breathing gas, a gas recirculation connection for breathing gas. The switching unit, the breathing gas metering path, the connection element close to the patient, the gas return connection for inhalation gas and the gas extraction connection are designed and configured as described in the context of the system according to the invention for a gaseous supply of substances according to the first inventive aspect. The common structural unit has connections for connection to the oxygenation system and the dosing system, the ventilation system and with the patient. The breathing gas metering path and the gas recirculation connection can preferably be implemented in the gas distribution unit and, for example, as internal lines. The purging gas metering path, the breathing gas connection system can preferably be formed by the gas distribution unit and for example as lines, e.g. in the form of ventilation hoses or hose lines to the oxygenation system or to the patient and the ventilation system. Likewise, the feed line from the gas extraction connection to the dosing system or the system for inhalative sedation (SIS) is preferably designed, for example, as a hose line.

Overall, the essential advantage of the present invention with the first as well as the further inventive aspect is that the system for supplying substances in a combination of ventilation system, system for inhalative sedation (SIS) and oxygenation system enables the administration of inhalative substances can be carried out via the patient's lungs, as well as extracorporeally into the patient's bloodstream.

In a preferred embodiment, the gas distribution unit can be the reflection unit and / or the HME filter and / or the further Include filter element in the common structural unit. The reflection unit and / or the HME filter are designed and configured as described in the context of the system according to the invention for a gaseous supply of substances according to the first inventive aspect

In a preferred embodiment, the gas distribution unit and / or the connection element close to the patient can have a connection for a measurement gas line which is provided for connection to a process gas analysis unit.

In a further preferred embodiment, a humidification / heating system for breathing gas, which is provided for heating breathing gases, can be installed in or on the gas distribution unit, in or on the switchover unit, in or on the connecting element close to the patient, in / or on the breathing gas connection system, be arranged.

In a further preferred embodiment, a mixing chamber, which is provided for supplying exhalation gases to the patient by means of an exhaust line for exhalation gases, can be arranged in or on the gas distribution unit. With the exhaust line there is the possibility, at least in part, of not having to continuously dispose of quantities of inhalative substances in the exhaled gas, but instead the possibility of reusing these quantities of inhalative substances. This results in potential savings for inhaled substances, which brings cost advantages as well as a reduction in the supply of climate-damaging gases into the environment.

In a further preferred embodiment, the exhaust line for exhaled gases, the gas splitting unit or the mixing chamber has a further absorber unit which is provided for removing carbon dioxide from the patient's exhaled gas. This additional absorber unit enables carbon dioxide to be removed from the exhaled gas, so that, regardless of the breathing phases or the respective setting of the switching unit for division into breathing gas dosing path and flushing gas dosing path, a continuous reuse of returned residual amounts of inhaled substances in the exhaled gas can be made possible .

In a further preferred embodiment of the system - also including the gas distribution unit according to the further inventive aspect - an arrangement with a flushing gas absorber unit and / or a further gas delivery unit, for example designed as a blower for transporting flushing gas in the oxygenation system or the purge gas metering path can be arranged and provided. The purge gas absorber unit removes the amount of carbon dioxide from the exhaled breathing gas, so that quantities of inhaled substances or volatile anesthetics (anesthetics) not absorbed by the patient can be used again for therapy after carbon dioxide has been removed from the circulation. The flushing gas absorber unit contains a special type of lime granulate (sodalime), known as soda lime, mostly consisting of calcium hydroxide [Ca (OH) ₂ ] and / or sodium hydroxide [Na OH]. The carbon dioxide content is removed from the exhaled gas by means of a chemical reaction, releasing heat and water. An exhaust gas outlet (waste) is provided in the ventilation system, via which the used amounts of exhaled breathing gas can be disposed of. This further preferred embodiment offers the advantage that flushing gas prepared by means of the flushing gas absorber unit can be fed back into the flushing gas metering path and then can get back into the patient's bloodstream at the membrane by means of the oxygenation connection system. Such an arrangement for return can be referred to as a so-called circle system. The purge gas absorber unit removes the proportion of carbon dioxide delivered from the patient's bloodstream from the purge gas, so that quantities of inhaled substances or volatile anesthetics (anesthetics) not absorbed by the patient can be reused for therapy in the circulation. The further gas delivery unit enables the flushing gas to be circulated in a circular flow. This avoids the need for flushing gas enriched with inhaled substances or volatile anesthetics (anesthetics) to be passed on as used gas via an exhaust outlet directly after a single flow past the membrane and thus valuable substances cannot be used again for further therapy. Such a further gas delivery unit can be arranged in combination with the further flushing gas absorber unit as a module, for example as a type of plug-in module in the oxygenation system. The further gas delivery unit and the flushing gas absorber unit can be designed jointly or separately as independent units or modules, which can be connected to the oxygenation system as external modules, for example.

The flushing gas absorber unit is thus advantageously designed to remove a proportion of carbon dioxide from the flushing gas, so that quantities of inhalative substances or volatile anesthetics (anesthetics) that are not introduced into the bloodstream on the membrane are again in operation of the oxygenation system after removal of carbon dioxide Circuit used can be. The purging gas absorber unit of the oxygenation system contains a lime granulate (sodalime), mostly consisting of calcium hydroxide [Ca (OH) ₂ ] and / or sodium hydroxide [Na OH]. The carbon dioxide content is removed from the flushing gas by means of a chemical reaction, releasing heat and water. An exhaust gas outlet (waste) is provided in the oxygenation system, via which used amounts of purge gas can be fed to disposal. Most of the gas quantities used are fed into the hospital infrastructure using an anesthetic gas scavenger system (AGS: Anesthesia Gas Scavenger) and disposed of appropriately. After the analysis, the gas quantities fed to the process gas analysis units are mostly fed into the hospital infrastructure and disposed of. In some cases, however, these analyzed gas quantities can also be recycled and returned. Designs with an open anesthetic gas scavenger (ORS: Open Reservoir Scavenger) are also possible, in which case the expired exhaled gas is filtered or retained by means of an activated charcoal collector and then the filtered exhaled gas is fed into the room air.

In a particularly preferred embodiment of the system or the gas distribution unit, a mixing chamber is arranged in or on the switching unit or in or on the gas distribution unit, which is designed in cooperation with a supply line for exhaled gases from the ventilator to the switching unit, quantities or partial quantities of inhaled substances in the exhaled gas, which in the normal operation of the system for a supply of substances via the exhalation valve (exhalation valve) of the ventilation system and the exhaust gas outlet for disposal to use again in further operation of the system and the course of therapy. The exhaled gas has proportions of carbon dioxide which can be removed from the exhaled gas by means of the flushing gas absorber unit in a preferred embodiment of the oxygenation system.

In this way, it is possible, at least in certain time segments in the course of ventilation therapy, to introduce partial amounts of exhaled gas with remaining parts of inhalative substances - after removing the carbon dioxide parts - through the membrane of the oxygenation system into the patient's bloodstream and thus not have to dispose of it.

In preferred embodiments of the system, in addition to the above-described configuration of a preferred embodiment as a measuring system for process gas analysis (PGA) for determining a gas concentration, a further or more process gas analysis units (PGA) for analyzing gases, gas mixtures, liquids and / or amounts of blood arranged in the system or assigned to the system - also with the inclusion of the gas distribution unit according to the further inventive aspect. These process gas analysis units can provide certain data and / or information to the control unit and / or to the control system or individual control units on the basis of the analysis. These further preferred embodiments offer the advantage that functional monitoring of the dosages of the inhalative, volatile substances or anesthetic agents can be carried out continuously during operation and the effect of dosages and / or changes in dosages on the patient or the patient's condition can be estimated on this basis. In the following, some exemplary options for the arrangement, assignment and use of process gas analysis units (PGA) in the system are explained in more detail.

In special embodiments, the process gas analysis units (PGA) can be arranged on individual components in the system and can thus be used for analysis independently of one another. However, it is also possible, and in the context of the present invention, as an alternative further embodiment, that a process gas analysis unit (PGA-Z) arranged centrally in the system with an additional switchover and distribution control unit, for example designed as controllable and / or controlled valve arrangements, is a type of a Analysis center trains. The ventilation system, the oxygenation system and possibly also the system for inhalative sedation or the dosing system or the switchover unit provide corresponding gas samples by means of the switchover and distribution control unit to the central process gas analysis unit (PGA-Z) and then from the central process gas analysis unit ( PGA-Z) serially analyzed one after the other as required.

The switching and distribution control unit is equipped with means for switching, distributing and supplying gas samples of the individual components in the system, in particular from the inhalative sedation system (SIS), oxygenation system, oxygenation connection system, dosing system, switchover unit, gas distribution unit, patient-related connection element of the central process gas analysis unit (PGA -Z) to be supplied and made available for an analysis and to coordinate the supply of the gas samples. This further preferred embodiment offers the advantage that a process gas analysis unit (PGA) does not have to be arranged on each unit or on each module of the system. This can reduce the constructive and operational expenditure on components such as sensors, power supply, interfaces and operating software Simplify the function and cooperation, especially in the configuration with a central control unit. The results of the analysis can then be made available to the individual control units or the central control unit in a decentralized or centralized manner. In a special embodiment, a blood gas analysis unit can also be integrated into the process gas analysis unit (PGA-Z) arranged centrally in the system. A further process gas analysis unit of this type can be arranged in or on the oxygenation system in or on the oxygenation connection system for analyzing purge gases, or it can be assigned to the oxygenation system or the oxygenation connection system. This further process gas analysis unit (PGA-OS) can provide certain data to the control unit and / or to an individual control unit on the basis of the analysis. For an extracorporeal membrane oxygenation to be carried out, knowledge of the concentrations of carbon dioxide and / or oxygen in the flushing gas is relevant.

A particular embodiment of the process gas analysis unit can, in a preferred embodiment, be designed as an embodiment of a blood gas analysis unit (BGA) for analyzing blood quantities. This blood gas analysis unit according to this preferred embodiment can be arranged in or on the oxygenation system, or in or on the oxygenation connection system, or be assigned to the oxygenation system or the oxygenation connection system. The blood gas analysis unit (BGA) enables the gases or gas mixtures dissolved in the patient's blood to be analyzed, so that the blood gas analysis unit (BGA), for example, has knowledge of a gas distribution (partial pressure) of O ₂ (oxygen), CO ₂ (carbon dioxide) and the pH value and the acid-base balance in the blood. The blood gas analysis unit can provide specific data to the control unit and / or to an individual control unit on the basis of the analysis.

Knowledge of these values can often be of interest or relevance for assessing the effect of anesthesia, ventilation and / or extracorporeal membrane oxygenation. This further preferred embodiment offers the advantage of using the knowledge of gas distribution (partial pressure) of O ₂ (oxygen), CO ₂ (carbon dioxide) for monitoring the control of the oxygenation system. In addition, with the help of the values obtained with regard to the acid-base balance and the pH value in the blood, meaningful information for the user with regard to the general condition of the patient and with regard to the implementation of the therapy can be provided. In addition, this blood gas analysis unit (BGA) can also check and / or monitor the function of the oxygenation system (oxygenator quality) during use. In this way, the user can then be given timely information about the current state, such as possible future changes in state or changes in the properties of the oxygenator or membrane. The function of the oxygenation system can be impaired, for example, by coagulation effects (coagulation, clotting). Such a blood gas analysis unit (BGA) can be arranged in combination with the process gas analysis unit (PGA-OS) as a module, for example as a type of plug-in module in the oxygenation system. The blood gas analysis unit (BGA) and the process gas analysis unit (PGA-OS) can also be designed jointly or separately as independent units or modules which, for example, can be connected to the oxygenation system as external modules. This combination and design as a module, in particular and for example as a plug-in module, offers the advantage that the oxygenation system can optionally be equipped with modules adapted to the situation, so that the oxygenation system can be equipped with modules for blood gas analysis (BGA) and / or process gas analysis before use can be set up. Such a process gas analysis unit for analyzing breathing gases can be arranged in or on the inhalative sedation system (SIS) or in or on the breathing gas connection system or assigned to the inhalation sedation system (SIS) or the breathing gas connection system be. This process gas analysis unit (PGA-SIS) can correspond to the measuring system mentioned above in the context of the description of the dosing system for a process gas analysis to determine a gas concentration, or it can be designed in the same way and with the same effect. This process gas analysis unit (PGA-SIS) can provide certain data to the control unit and / or to an individual control unit on the basis of the analysis. The process gas analysis unit can be used to determine the concentrations of certain gases in the breathing gas, the knowledge of which is relevant for performing ventilation or anesthesia.

Knowledge of the concentrations of carbon dioxide and oxygen in the breathing gas is relevant for performing ventilation as well as performing anesthesia. Furthermore, knowledge of the concentrations of gases or inhaled substances, substances for inhalative sedation or anesthetics (anesthetics), for example halothane, isoflurane, desflurane, sevoflurane or ether, may be relevant.

In a preferred embodiment of the system, a process gas analysis unit for analysis is arranged in or on the metering system or is assigned to the metering system. This process gas analysis unit (PGA-DS) can do the previously mentioned within the scope of the description of the metering system correspond to a process gas analysis for a determination of a gas concentration, or be designed in the same way and with the same effect. This process gas analysis unit (PGA-DS) can - in a manner similar to the process gas analysis unit, which is arranged on the ventilation system for analysis - carry out a gas analysis with regard to the concentrations of certain gases. In this way, concentrations of gases (oxygen, nitrous oxide, or inhalative substances, substances for inhalative sedation or anesthetics (anesthetics), for example halothane, isoflurane, desflurane, sevoflurane or ether, as well as oxygen, nitrous oxide, (N ₂ O), Laughing gas, heliox, nitrogen monoxide can be determined and so this process gas analysis unit (PGA-DS) can provide certain data to the control unit and / or to an individual control unit on the basis of this analysis. This further preferred embodiment offers the advantage that the composition in the breathing gas with concentrations Substances, anesthetics, oxygen, nitrous oxide and other gases are continuously known in operation and control and monitoring, as well as regulation of the dosage of gases by the control unit in the dosing system itself or in a central control unit, is made possible.

In a preferred embodiment of the system, a process gas analysis unit for analysis is arranged in or on the switchover unit or is assigned to the switchover unit. This process gas analysis unit (PGA-US) can - in a similar way to the process gas analysis unit, which is arranged on the dosing system for analysis, Determine halothane, isoflurane, desflurane, sevoflurane or ether as well as oxygen and provide certain data to the central control unit and / or to an individual control unit on the basis of this analysis.

This further preferred embodiment offers the advantage that the composition in the breathing gas is known during the operation of the system for a supply of substances and a control with regard to the division of the enriched into the breathing gas dosing path and the flushing gas dosing path, including information on concentrations in the Control unit is made possible in the switching unit, in the dosing system or in a central control unit.

The provision of data and / or information in the system between the process gas analysis units, control unit, individual control units, designed for example as control modules, can take place with the aid of data lines or data connections. The data lines or data connections are preferably designed as a wired or wireless data network (Ethernet, LAN, WLAN, Bluetooth, PAN) or bus system (CAN, LON), which is a data node for data coordination (switch, hub, router) on the one hand, as well as components (database , Server, router, access point) for data storage and data distribution. For example, a database system for organizing patient data in the form of a patient data management system (PMS) can be connected to the data network which, in addition to diagnoses and therapy information pertaining to patients, also receives the data and / or measured values from the process gas analysis units relating to these patients, stores them as data sets and accesses them organized on it. As a central element of the system, the data network or bus system can also organize the cooperation of the individual control units with a central control unit, so that at least some of the components of the system, for example ventilation system, inhalation sedation system (SIS), oxygenation system, dosing system, switching unit, control units, individual control units, control modules, process gas analysis units are connected to one another by means of the data network or bus system and can work together in a coordinated manner. Changes in the implementation of therapy with ventilation, extracorporeal oxygenation and decarboxylation can then advantageously be combined with patient data, diagnostic data such as EKG, EIT, laboratory data such as blood, urine, cerebrospinal fluid, liquor, respiratory gases or blood gases in a common display The display unit integrated in the data network can be displayed in combination, which makes the effects of therapy changes visible and verifiable for the user in a timely manner.

With data lines or data connections, wired or wireless data networks (Ethernet, LAN, WLAN, Bluetooth, PAN) or bus systems (CAN, LON), data nodes for data coordination (switch, hub, router), components (database, server, router, access point ) for data storage, data distribution, a further preferred embodiment of a data network and / or network system can be formed, which is designed and provided to store data in the system, the control unit or the individual control units, the blood gas analysis unit, the process gas analysis units, the ventilation system, the system Inhalative sedation (SIS), the oxygenation system, the switching unit, the dosing system or other components to be provided and coordinated.

In a preferred embodiment of the system - also including the gas distribution unit according to the further inventive aspect - a system for physiological patient monitoring (PPM) can be arranged in the system for supplying substances or assigned to the system. This further preferred embodiment offers the advantage that the effect of the administration of volatile substances and / or drugs and / or anesthetics on the patient's condition using physiological measured variables such as oxygen saturation in the blood (SPO ₂ ), carbon dioxide concentration during and at the end of the Exhalation phase (end-tidal carbon dioxide concentration, etCO ₂ ), heart rate, blood pressure, body temperature is monitored using measurements. From these measured variables, the user can draw conclusions about the current therapy situation, both of the blood gas exchange in the lungs and of the extracorporeal blood gas exchange with regard to the removal of carbon dioxide and the supply of oxygen. In addition, it is possible to use the oxygen saturation in the blood (SPO ₂ ) as a control variable for the metering of oxygen in the metering system; furthermore, the distribution of gas quantities to the ventilation system or the system for inhalative sedation (SIS ) and the oxygenation system. The carbon dioxide concentration can serve as the basis for controlling the extracorporeal blood gas exchange through the oxygenation system, which can be done, for example, by adapting the delivery rates to the blood delivery unit and / or flow rates of the flushing gas.

In a preferred embodiment of the system - also including the gas distribution unit according to the further inventive aspect - for supplying substances, a system for imaging and diagnosing heart and lungs can be arranged in the system or assigned to the system.

This further preferred embodiment offers the advantage that the condition of the lungs, in particular changes (improvement, recovery, deterioration) in the situation of the lungs during the therapy, can be followed during the therapy. Suitable imaging systems are, for example, ultrasound diagnostics, electro-impedance tomography (EIT), computer tomography (CT), X-rays (X-ray), magnetic resonance tomography (MRT). Electro-impedance tomography (EIT) deserves special mention because - in contrast to the other four systems mentioned - it offers the possibility of continuous imaging of the lungs, thorax and heart. In this way, global and / or regional changes in the state of the lungs, the type of ventilation of the lungs with possibly regional overextensions and collapses can be made visible. Changes to the type of ventilation by the ventilation system and the type and manner of combined use with the oxygenation system for extracorporeal blood gas exchange are thus visually visible and verifiable for the user in real time.

A particularly preferred embodiment of the system - also including the gas distribution unit according to the further inventive aspect - enables data to be exchanged within the system with components of the system and with the data network or network system by providing data. Data can be exchanged between the ventilation system, oxygenation system, inhalation sedation system, dosing system, switching unit, control units, process gas analysis units, blood gas analysis units, a system for imaging and diagnosing heart and lungs or a system for physiological patient monitoring (PPM) with one another or with the data network or network system. In this way, the control unit of the switchover unit, the control unit of the dosing system or the individual control units in the system can be enabled to control and / or coordinate the switchover unit and / or the dosing unit. This further preferred embodiment offers the advantage that the aforementioned advantages of control options and verifiability of effects and interactions of the ventilation system, system for inhalative sedation, dosing system, switching unit, oxygenation system combined with one another can be provided for the user. The data exchange makes it possible to compare and combine data in a temporal context and to present and document the trend of the therapy holistically.

In a further preferred embodiment, the control unit in the dosing system can be designed to control the amount of inhaled substances as a function of the data provided in the data network or network system and / or as a function of the data provided by one of the control units. For example, the dosing of the quantities of inhaled substance dosed by the dosing system can be determined by the blood gas analysis units (BGA ), Measured values of the process gas analysis units (PGA), for example concentrations of oxygen and carbon dioxide in the breathing gas or measured values of the physiological patient monitoring (PPM), which states or Indicate situations of the cardiovascular system, for example blood pressure, heart rate, EKG.

In further preferred embodiments of the system or the gas distribution unit, the control unit can be formed in the switchover unit, depending on the data provided in the data network or network system and / or depending on the data provided by one of the control units, the distribution and / or the division of the quantity inhalative substances in the purge gas metering path to the oxygenation system and the breathing gas metering path to the patient-near connecting element or to the reflection unit. In particular, the control unit can, on the basis of data which indicate a current lung condition of the patient and are provided, for example, by a system for imaging and diagnosing the heart and lungs in the data network or network system, the distribution and division of the subsets of breathing gas enriched with inhaled substances in coordinate or control the patient's lungs or into the patient's bloodstream via the oxygenation system. With EIT diagnostics systems (EIT system), possible changes in the state of the lungs can be made visible continuously and promptly during therapy. The effects of ventilation and the way in which it is used in combination with the oxygenation system are visible and verifiable for the user in a timely manner. If, for example, data is provided by an EIT system in the network, which indicates a current state of a ventilation situation of the lungs or changes, or a trend in the ventilation situation of the patient's lungs, then the control unit of the switching unit can use this to determine the distribution of the quantities of inhaled substances and / or control levels of oxygen in the patient's bloodstream or respiratory system.

For example, in the case of a deteriorating ventilation situation, i.e. with the EIT system, it can be determined that lung areas are either no longer adequately ventilated (ventilation) or no longer adequately supplied with blood (perfusion) or are neither adequately ventilated nor adequately supplied with blood, the control unit cause the switchover unit to do so to distribute the breathing gas enriched with inhalative substances and possibly oxygen between the breathing gas metering path and the purging gas metering path with an increase in the partial amount of breathing gas in the purging gas metering path. In the event of an improvement in the situation of the patient's lungs determined by means of the EIT system, for example as a result of a recovery or recovery of the patient's lungs in the course of the therapy, the control unit can cause the switching unit to distribute the inhaled substances and possibly oxygen enriched breathing gas between breathing gas metering path and flushing gas metering path with an increase in the partial amount of breathing gas in the breathing gas metering path.

The present invention will now be explained in more detail with the aid of the following figures and the associated description of the figures, without restricting the general inventive concept.

• die 1 eine erste schematische Darstellung eines Systems zu einer Zuführung von inhalativen Substanzen,
• die 2 eine zweite schematische Darstellung eines Systems zu einer Zuführung von inhalativen Substanzen,
• die 3 eine dritte schematische Darstellung eines Systems zu einer Zuführung von inhalativen Substanzen.

Show it:

• the 1 a first schematic representation of a system for supplying inhalative substances,
• the 2 a second schematic representation of a system for supplying inhalative substances,
• the 3 a third schematic representation of a system for supplying inhalative substances.

the 1 shows a schematic representation of a patient 30th and a system 1000 for ventilation with oxygenation and decarboxylation with the main main components: the ventilator as the ventilation system 1 , Oxygenation system 2 , Breathing gas dosing path 3 , Purge gas dosing path 4th , Breathing gas connection system 5 , Oxygenation connection system 6th , Dosing system 7th , Switching unit 8th , Gas sampling connection 16 , Gas recirculation connection 24 , connecting element close to the patient 25th , Reflection unit 18th , Feed line 103 and at least one to control the dosing system 7th provided and trained control unit 9 .

The patient 30th is connected to the ventilation system 1 by means of the breathing gas connection system 5 and the near-patient connector 25th , by means of an endotracheal tube 33 and an airway access 32 fluidly connected for the supply and continuation of breathing gases. Alternative to the endotracheal tube 33 a nasal mask or tracheostoma can also be used. The inhalative sedation system (SIS) 17th is essentially formed by the dosing system 7th , the gas sampling connection 16 for extracting partial amounts of breathing gas from the breathing gas, the reflection unit 18th and the gas recirculation connection 24 for returning the partial quantities of breathing gas from the switching unit 8th to the reflection unit 18th . The inhalative sedation system (SIS) 17th is made by means of the breathing gas connection system 5 and the gas extraction connection 16 a subset of breathing gas from the ventilator 1 provided and supplied. By means of a further component / further path of the breathing gas connection system 5 is from the ventilation system 1 another, not with Inhaled substances enriched amount of breathing gas via the connecting element close to the patient 25th the airways 32 of the patient 30th via an endotracheal tube 33 , Nasal mask or tracheostoma supplied directly. From the dosing system 7th the partial amount of breathing gas enriched with inhalative substances arrives via the supply line 103 to the switching unit 8th . From the switching unit 8th is by means of the breathing gas dosing path 3 the partial amount of breathing gas enriched with inhaled substances via the gas recirculation connection 24 on the connecting element close to the patient 25th the airways 32 of the patient 30th fed. From the switching unit 8th is by means of the purge gas dosing path 4th the partial amount enriched with inhaled substances to the oxygenation system 2 fed. The switching unit 8th enables the division and / or distribution of gas quantities enriched with inhalative substances in the breathing gas metering path 3 and the purge gas metering path 4th . From the oxygenation system 2 are by means of one in the purge gas metering path 4th flowing purge gas via the oxygenation connection system 6th and an invasive fluid access 31 Amounts of blood enriched with inhaled substances in the patient's bloodstream 30th fed. On one in the oxygenation system 2 arranged membrane 35 takes place in the oxygenation system 2 a gas for blood exchange and a gas for blood exchange. Amounts of gas enriched with oxygen O ₂ and the inhaled substances from the oxygenation connection system 6th reach the membrane by rinsing 35 into the patient's bloodstream 30th and at the same time, amounts of carbon dioxide CO _{2 are released} from the patient's bloodstream 30th into the purge gas metering path 4th . The ventilation system 1 is to provide breathing gases to the patient 30th educated.

The ventilation system 1 is part of a ventilator in the usual configuration. Ventilation systems 1 for ventilators usually have means for providing, supplying and conveying respiratory gases and substances to and from the patient, for example means for gas mixing 67 and gas extraction 27 , for example a gas mixer and at least one gas delivery unit (blower, blower, piston drive, valve arrangement), as well as means for supplying gas, such as a gas connection 60 for a supply of gases such as air and oxygen, the breathing gas connection system 5 , for example designed in the form of an inspiratory breathing tube and often also an expiratory breathing tube and the connecting element close to the patient 25th - the so-called Y-piece - to connect the ventilation hoses to the endotracheal tube 33 , Breathing mask or tracheostomy. Furthermore, a ventilation system 1 an exhalation valve (exhalation valve) 20th through which the breathing gas connection system via the expiratory ventilation hose 5 to the ventilator 1 recirculated exhalation gases then with the exhalation of the patient 30th via an exhaust outlet 300 can get into the environment or can be captured or conveyed away by means of a system for the collection and recovery of used gas quantities. There are also alternative connecting elements close to the patient 25th known, which include an exhalation valve close to the patient. In addition to the ventilation system 1 conventionally designed ventilators also have elements - in particular sensors - for metrological recording of given and / or set pressures, flow rates and other operating parameters of mechanical ventilation with the supply of gases and gas mixtures. For a process of mechanical ventilation, at least the following parameters such as inspiratory and expiratory ventilation pressures, ventilation frequency, inspiration to expiration ratio, pressure upper and lower limits, flow rate upper and lower limits, volume upper and lower limits and gas concentrations are controlled by a control unit 10 set and / or monitored with the help of sensors. This sensor system is shown for the sake of clarity 1000 in this 1 not shown. The dosing system 7th is by means of a control unit 12th and a metering element 101 designed for automated dosing from a reservoir 100 with inhalative substances and / or volatile anesthetic agent, a predetermined amount of the substances and / or volatile anesthetic agent in addition to the partial amount of inhaled gas in the supply line 103 to dose.

An anesthetic warming 102 can from the control unit 12th activated to be in liquid form in the reservoir 100 to convert existing inhaled substances into a gaseous state of aggregation. An alternative design variant for manual dosing or gas mixing would be an arrangement of so-called flow tubes, which can enable gas mixing and / or dosing of inhaled substances or anesthetics in the interaction of needle valves and a variable area flow meter arranged in a riser. The switching unit 8th is by means of the control unit 9 to a distribution or division of the amount of the gas enriched with inhalative substances in the supply line 103 to the oxygenation system 2 or towards the connecting element close to the patient 25th educated. The dosing system 7th and the switching unit 8th are in this 1 shown as separate units, in embodiments in practice the switchover unit 8th but also as an assembly of the dosing system 7th be designed. The connecting element close to the patient 25th and the reflection unit 18th are in this 1 together with the gas return connection 24 shown as a common unit. In practical embodiments, the connecting element close to the patient 25th , the reflection unit 18th and the gas recirculation connection 24 can also be designed as separate units. The connecting element close to the patient 25th , the reflection unit 18th , the gas recirculation connection 24 are in this 1 separate from the gas sampling connection 16 shown. In practical embodiments, the connecting element close to the patient 25th , the reflection unit 18th , the gas recirculation connection 24 and the gas extraction connection 16 as a common structural unit, for example integrated in the connecting element close to the patient 25th be designed. The control units 9 , 10 , 11th , 12th can be designed modularly or designed as a common control unit, as well as a central control unit 15th ( 2 ) of the system 1000 , or Systems 2000 ( 2 ) train. In the ventilation system 1 takes place by means of the gas mixer 67 a mixture of by means of a gas connection 60 provided gases. The gas connection 60 the gases oxygen and medical air are usually supplied by means of a central gas supply unit (ZV). From the ventilation system 1 A total amount of breathing gas passes through the breathing gas connection system 5 to the patient 30th . From the breathing gas connection system 5 a partial amount of breathing gas is supplied via the gas extraction connection 16 removed and the dosing system 7th fed.

In the ventilation system 1 takes place by means of a control unit 10 a control of a gas delivery unit 27 or an alternatively usable piston drive to deliver the breathing gas to the patient 30th , as well as the continuation of used breathing gases from the patient 30th . The control unit 10 controlled by means of an exhalation valve (exhalation valve) 20th and the gas delivery unit 27 the ventilation sequence with inspiratory and expiratory ventilation pressures, tidal volumes, flow rates and other ventilation settings. The breathing gas connection system 5 consists of an inspiratory breathing hose to supply the breathing gas and an expiratory breathing hose to carry the patient's exhaled gas 30th , which by means of the connecting element close to the patient 25th , the so-called Y-piece, together to connect the patient 30th are connected. The one used to control the ventilation system 1 The setting and display elements, sensors for pressure and flow measurements, valves, check valves and other components required for ventilation and ventilation are included in this for the sake of clarity 1 not shown. The patient 30th comes with the oxygenation system 2 by means of the oxygenation connection system 6th to a promotion with the supply and removal of blood quantities into the blood circulation via an invasive fluid access 31 tied together. The connection of the patient 30th to the oxygenation system 2 can be via a fluid connection 37 take place, which is designed for a pump-free extracorporeal membrane oxygenation. The amount of blood is transported to the patient 30th to and from the patient 30th continued in such an embodiment through the pumping capacity of the heart of the patient himself. This embodiment is referred to as pumpless extracorporeal membrane oxygenation or pumpless extracorporeal lung support (pECLA). The connection of the patient 30th to the oxygenation system 2 but mostly takes place by means of a blood delivery unit 36 , mostly designed as a pump. From the switching unit 8th the gas enriched with inhalative or volatile substances or anesthetics arrives as flushing gas by means of the flushing gas metering path 4th to a gas connection 34 on the oxygenation system 2 . The oxygenation system 2 controlled by a control unit 11th a flow rate and flow rate of the inflow of purge gas to the membrane 35 . The membrane is designed to introduce oxygen from the flushing gas into the blood and to conduct carbon dioxide from the blood into the flushing gas. In this way, a blood-to-gas exchange takes place outside the body (extracorporeal).

The continued to control the oxygenation system 7th and carrying out the extracorporeal enrichment with oxygen (oxygenation) and removal of carbon dioxide (decarboxylation), the necessary setting and display elements, sensors for pressure and flow measurements, valves and other components are included in this for the sake of clarity 1 not shown. As further essential components of the system 1000 is one of the oxygenation system 2 assigned process gas analysis unit 21 (PGA) for an analysis of the gas composition of the purge gas. The process gas analysis unit 21 shows in addition to the measuring elements for the determination of gas concentrations also - in this 1 not shown - elements for display and representation, as well as operating elements, which enable a user to read and operate. The oxygenation system 2 assigned process gas analysis unit 21 is designed to analyze the gas composition of the purge gas. The purge gas becomes the process gas analysis unit 21 and is in the process gas analysis unit 21 analyzed to the ratios of carbon dioxide and oxygen at the membrane 35 to monitor, so to determine the gas exchange and the transfer rate between the blood circuit and the flushing gas and by means of the control unit 11th then to provide adequate control of oxygenation and decarboxylation for the patient. The amount of gas used is determined by the oxygenation system 2 and from the ventilation system 1 above accordingly provided and in this 1 not shown - valve arrangements via the exhaust gas outlet (waste) 300 out of the system 1000 continued. In most cases, these used gas quantities are fed into the hospital infrastructure by means of an anesthetic gas scavenging system from the anesthesia machine and are then appropriately disposed of. Depending on the division into the breathing circuit or the blood circuit, the system is used 1000 to a supply of substances of oxygenation and decarboxylation inhalation at the same time with the implementation of the ventilation with a gas-to-blood exchange in the lungs of the patient 30th and / or extracorporeally with a gas-to-blood exchange on the membrane 35 of the oxygenation system 2 . Via the switching unit 8th the ratio between inhalation and extracorporeal administration of the inhalation substances is adjustable for the user. The user is supported by the measured values and status values of the process gas analysis unit (PGA) 21 of the oxygenation system 2 to disposal.

There can be data interfaces 211 on the ventilation system 1 , Oxygenation system 2 , Dosing system 7th , Switching unit 8th be provided, which a unidirectional and / or bidirectional data exchange between ventilation system 1 , Oxygenation system 2 , Dosing system 7th , Switching unit 8th and inhalative sedation system (SIS) 17th can enable. Such a data exchange is preferably carried out in the interaction and communication of the control units 9 , 10 , 11th , 12th in ventilation system 1 , Oxygenation system 2 , Inhalative Sedation System (SIS) 17th , Dosing system 7th , Switching unit 8th organized, initiated or coordinated. The data interfaces are by means of - for reasons of clarity of the graphic representation in this 1 not shown - data lines 210 ( 2 ) wired or wirelessly connected to each other. Also can be another - in this one 1 not shown - central control unit 15th ( 2 ) in the system 1000 , as well as in the systems 2000 ( 2 ) and 3000 ( 3 ) arranged and provided via data lines 210 ( 2 ) the interaction in the system 1000 of ventilation system 1 , Oxygenation system 2 , Inhalative Sedation System (SIS) 17th , Dosing system 7th , Switching unit 8th , possibly also with other components 212 , 213 ( 2 ) Database, server, router, access point, hub) in a data network 212 ( 2 ) (LAN, WLAN, Bluetooth, PAN, Ethernet) or network system.

the 2 shows a system 2000 with options for extended system configurations 1000 to ventilation with oxygenation and decarboxylation after the 1 on.
Same components in the 1 and in the 2 are in the 1 and 2 denoted by the same reference numerals.
In addition to the system 1000 ( 1 ) in the in the 1 elements and components shown and described 1 , 2 , 3 , 4th , 5 , 6th , 7th , 8th , 9 , 10 , 11th , 12th , 16 , 17th , 18th , 20th , 21 , 24 , 25th , 27 , 30th , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 60 , 67 , 100 , 101 , 102 , 103 , 211 , 300 are additional features and components 15th , 19th , 22nd , 23 , 26th , 28 , 38 , 39 , 70 , 75 , 210 , 212 , 213 in the extended system 2000 after 2 available.

So shows the extended system 2000 a further gas delivery unit (blower, blower) 38 and a flushing gas absorber unit (carbon dioxide absorber) 39 in the oxygenation system 2 on. Such a further gas delivery unit 38 can be used in combination with the purge gas absorber unit 39 as a module, for example as a type of plug-in module in the oxygenation system 2 be arranged.

The further gas delivery unit 38 as well as the purge gas absorber unit 39 , can also be designed jointly or separately as independent units or modules, which, for example, as external modules with the oxygenation system 2 can be connected. So shows the extended system 2000 one to the connecting element close to the patient 25th connectable or connectable with this measuring gas line (sample line) 26, through which samples of the patient 30th given breathing gas to a further process gas analysis unit 23 or blood gas analysis unit 23 are supplied, so that the process gas analysis unit 23 or blood gas analysis unit 23 is metrologically able to determine concentrations of oxygen, carbon dioxide, or inhaled substances, for example anesthetics (anesthetic agents), and to determine measured values which indicate these concentrations and for the control of the system 2000 provide. The extended system can be used for further analysis 2000 also a blood gas analysis unit (BGA) 22nd for the analysis of blood gases in the patient's blood 30th in the oxygenation system 2 exhibit. A blood gas analysis provides, for example, information regarding a gas distribution (partial pressure) of O ₂ (oxygen), CO ₂ (carbon dioxide) as well as the pH value and the acid-base balance in the patient's blood 30th include. Such a blood gas analysis unit 22nd (BGA) can in combination with the process gas analysis unit (PGA) 21 as a module, for example as a type of plug-in module in the oxygenation system 2 be arranged. The blood gas analysis unit 22nd (BGA) and the process gas analysis unit (PGA) 21 can also be designed jointly or separately as independent units or modules, which, for example, as external modules with the oxygenation system 2 can be connected. The switching unit 8th and the dosing unit 7th can also be implemented in a common structural unit so that also the process gas analysis unit 23 or the blood gas analysis unit 23 then within the common structural unit both in or on the dosing unit 7th as well as the switching unit 8th can be arranged. The configuration of a common structural unit with an arrangement of process gas analysis unit or blood gas analysis unit is included in this for the sake of clarity 2 not shown. The extended system 2000 shows a humidifying and / or heating system as a further component 75 for the temperature control of breathing gases in the breathing gas connection system 5 .

the 3 shows a system 3000 with extensions to the design of the systems 1000 , 2000 to ventilation with oxygenation and decarboxylation after the 1 or 2 on. Same components in the 1 , 2 , 3 are in the 1 , 2 and 3 denoted by the same reference numerals.

In addition to the system 2000 ( 2 ) in the 2 elements and components shown and described 1 , 2 , 3 , 4th , 5 , 6th , 7th , 8th , 9 , 10 , 11th , 12th , 15th , 16 , 17th , 18th , 19th , 20th , 21 , 22nd , 23 , 24 , 25th , 26th , 27 , 28 , 30th , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 60 , 67 , 70 , 75 , 100 , 101 , 102 , 103 , 210 , 211 , 212 , 213 , 300 are additional components 19th , 29 in the extended system 3000 after 3 available. So the switching unit 8th a mixing chamber 19th on. This mixing chamber 19th is designed and provided for this purpose, at least subsets of the exhaled gases of the patient 30th , instead of this - as in the configurations according to the 1 and 2 shown - from the exhaust outlet 300 to flow into the environment, by means of an exhaust pipe 29 in this mixing chamber 19th the switching unit 8th to record. From the mixing chamber 19th the switching unit 8th these subsets of exhaled gases can then be used together with the, by means of the supply line 103 from the dosing system 7th supplied and with inhalative substances enriched amounts of breathing gas to the switching unit 8th and then via the purge gas connection path 4th the oxygenation system 2 are fed. In the oxygenation system 2 is through the purge gas absorber unit 39 the concentration of carbon dioxide in the gas mixture is reduced and the amount of inhaled substances remaining after the patient has exhaled can be via the oxygenation system 2 again by means of the oxygenation connection system 6th are fed. In this way it is possible, depending on the selected distribution of the gas quantities with inhalative substances, between the oxygenation system 2 and ventilation system 1 through the switching unit 8th , at least during defined time periods in the course of ventilation by the ventilator 1 , Subsets of the patient's exhaled gas 30th to reuse any inhalative substances that are still present in the oxygenation system for extracorporeal gas exchange, instead of allowing them to flow into the environment via the exhaust gas outlet or having to dispose of them using a transfer or collection system (AGS: Anesthesia Gas Scavenger, ORS: Open Reservoir Scavenger). So results from the exhaust pipe 29 at least partially a possibility of not having to continuously dispose of quantities of inhaled substances in the exhaled gas, but instead the possibility of reusing these quantities of inhaled substances again. In particular, if the switching unit 8th is set in such a way that the distribution of inhalation gas enriched with inhalative substances is essentially via the flushing gas metering path to the oxygenation system 2 flows in, a considerable proportion of the residual amounts of inhaled substances in the exhaled gas returned to the ventilator in the exhaled gas then in the oxygenation system 2 be recycled.

Used in the exhaust pipe 29 , into the mixing chamber 19th the switching unit 8th or in the switchover unit 8th an optional additional absorber unit 68 is introduced, a removal of carbon dioxide from the exhaled gas is thus made possible, so that the division into breathing gas metering path is also independent of breathing phases or the respective setting in operation during operation 3 and purge gas metering path 4th After the CO ₂ removal, the possibility of continuously reusing the residual amounts of inhaled substances returned to the ventilator with the exhaled gas in the oxygenation system 2 is given can.

In the advanced systems 2000 , 3000 after the 2 and 3 can also use an additional process gas analysis unit (PGA) 23 , for example arranged on the switchover unit 8th , or on the dosing unit 7th to analyze the gas 103 in the oxygenation dosing path and / or in the breathing gas dosing path 3 , Purge gas metering path 4th , or from the dosing unit 7th exhibit. This provides information on the dosage and setting of the anesthetic dosage 100 , 101 , 102 by measuring the concentration in the gas 103 to be checked. Depending on the set distribution of the gas 103 into the breathing circuit or into the blood circuit to the switching unit 8th assign the gas in the breathing gas dosing path 3 and in the purge gas metering path 4th different concentrations of oxygen. The further process gas analysis unit (PGA) 23 can be useful to monitor this difference by measurement. In such an operating mode, the ventilation system is used 1 the anesthesia with the supply of volatile anesthetics (anesthetic agents), as well as with the supply of further substances, preferably volatile substances, inhalation at the same time with the implementation of the ventilation with a gas supply Blood exchange immediately in the patient's lungs 30th or extracorporeally with a gas-to-blood exchange on the membrane 35 of the oxygenation system 2 , depending on the user's wishes with different concentrations of oxygen in the breathing gas indirectly 5, 32, 33 to the patient's lungs 30th and indirectly 6, 31 into the patient's bloodstream 30th .

The ones in the 1 until 3 systems shown 1000 , 2000 , 3000 can lead to cooperation and common system operation by means of the data interfaces 211 , Data lines 210 in the data network 212 with the other medical devices or systems, for example with process gas analysis units (PGA) 20th , 21 , 23 , Blood gas analysis units (BGA) 22nd , the system for physiological patient monitoring (PPM) 40 as well as the system 50 for imaging and diagnostics of the heart and lungs 50 get connected.

For example, the system 1000 and the advanced systems 2000 , 3000 a system 40 for physiological patient monitoring (PPM). Such a system 40 for physiological patient monitoring has displays and representations of recorded, determined, analyzed or calculated physiological measurement data and / or parameters. These include, for example, metrological recordings of EKGs using EKG electrodes on the patient's upper body and EKG cables, recording of oxygen saturation (SPO ₂ ), for example on a patient's finger 30th , Acquisition of a non-invasive blood pressure reading using a blood pressure cuff on the patient's upper arm 30th Acquisition of an invasive blood pressure reading using an invasive access point on the patient's hand 30th , and a body temperature such as a skin temperature or a core body temperature of the patient 30th . Via an optional connection for gas extraction on the Y-piece 25th and / or another measuring gas line can take gas samples to one - in the 2 and 3 not shown in detail with - system 40 to physiological patient monitoring and gas analyzes are carried out therein, for example concentrations of carbon dioxide, methane or analyzes of other components such as alcohols (ethanol) in the exhaled gas. So can the control unit 12th in the dosing system 7th be designed, depending on the data network 212 or network system and / or as a function of the data provided by one of the control units 9 , 10 , 11th , 15th the data provided, the amount of inhaled substances 100 to control. For example, the metering in of the quantities of metered inhalative substance 1000 through the dosing system 7th depending on an oxygen or carbon dioxide partial pressure in the blood, the acid-base balance or pH value of the blood, concentrations of oxygen and carbon dioxide in the breathing gas or blood pressure, heart rate, EKG. You can also use the system 1000 and the advanced systems 2000 , 3000 an Indian 2 and 3 not shown in detail with - system 50 for imaging and diagnosis of the heart and lungs. Systems 50 for imaging and diagnostics of the heart and lungs are, for example, devices for computer tomography (CT diagnostics), magnetic resonance tomography (MRT diagnostics), X-ray devices (X-ray diagnostics), devices for electro-impedance tomography (EIT diagnostics, EIT system) or devices for ultrasound diagnostics (US diagnostics, sonography, Doppler sonography). The system 50 for imaging and diagnostics of the heart and lungs can provide the user with valuable information about the state of illness or recovery in the patient's lungs 30th is located.

Based on this, the user can configure the systems 1000 , 2000 , 3000 configure to focus on the delivery of oxygen to the patient 30th Inhalation on the way via the lungs or by means of extracorporeal membrane oxygenation (ECMO) invasively on the way via the bloodstream. In particular, devices for electro-impedance tomography (EIT diagnostics) enable continuous imaging of the lungs, thorax and heart - in contrast to CT diagnostics, X-ray diagnostics, MRT diagnostics, and US diagnostics. So can with systems 50 EIT diagnostics (EIT system) make possible changes in the state of the lungs visible continuously and promptly during therapy. The effects of ventilation and the way in which it is used in combination with the oxygenation system are visible and verifiable for the user in a timely manner. For example, are data from an EIT system 50 in the network 212 provided, which shows a current state of a ventilation situation of the lungs or changes, or a trend of the Ventilation situation of the patient's lungs 30th indicate, the control unit can based on this 9 the switching unit 8th the distribution of the quantities of inhaled substances 100 and / or amounts of oxygen in the patient's blood or breathing circuit 30th check. For example, if the ventilation situation deteriorates, ie with the EIT system 50 determines that lung areas are either no longer adequately ventilated (ventilation) or no longer adequately supplied with blood (perfusion) or are neither adequately ventilated nor adequately supplied with blood, the control unit 9 the switching unit 8th induce the distribution of inhaled substances 100 enriched breathing gas between breathing gas dosing path 3 and purge gas metering path 4th with an increase in the partial amount of breathing gas in the purge gas metering path 4th to undertake. One through the EIT system 50 identified improvement in the situation of the patient's lungs 30th , for example as a result of a recovery or recovery of the patient's lungs 30th in the course of the therapy the control unit 9 the switching unit 8th induce the distribution of inhaled substances 100 enriched breathing gas between breathing gas dosing path 3 and purge gas metering path 4th with an increase in the partial amount of breathing gas in the breathing gas metering path 3 to undertake.

List of reference symbols

1

Ventilation system (BS), ventilator

2

Oxygenation system (OS) (oxygenator)

3

Breathing gas dosing path

4th

Purge gas metering path

5

Breathing gas connection system

6th

Oxygen connection system

7th

Dosing system (DS)

8th

Switching unit

9

Control unit, control module (µC ₁ ) of the switching unit

10

Control unit, control module (µC ₂ ) of the ventilator / ventilation system

11th

Control unit, control module (µC ₃ ) of the oxygenation system (OS)

12th

Control unit, control module (µC ₄ ) of the dosing system (DS)

15th

external control unit, external control module (µC _M )

16

Gas withdrawal connection for inspiratory breathing gas, inhalation gas

17th

Inhalative Sedation System (SIS)

18th

Reflection unit (CR), element for anesthetic gas recovery, anesthetic gas reflector

19th

Mixing chamber on switching unit

20th

Exhalation valve of the ventilator

21

Process gas analysis (PGA, PGA-OS) of the oxygenation system

22nd

Blood gas analysis (BGA) of the oxygenation system

23

Process gas analysis (PGA, PGA-DS, PGA-SIS) of the dosing system

24

Gas return connection for inspiratory breathing gas, inhalation gas,

25th

connecting element close to the patient (Y-piece)

26th

Sample gas line

27

Gas delivery unit (blower, blower, piston drive) in the ventilation system

28

Filter element for moisture recovery (HME filter)

29

Exhaust line for exhaled gas

30th

Patient, living being

31

Invasive fluid access to the patient's bloodstream

32

Airway access, access to the patient's airway

33

Endotracheal tube, alternatively nasal mask or tracheostoma

34

Gas connection on the oxygenation system

35

Membrane, blood <-> gas exchange membrane, oxygenator membrane

36

Fluid connection with blood delivery unit (pump)

37

Fluid connection with pumpless extracorporeal membrane oxygenation

38

Additional gas delivery unit (blower, blower) in or on the oxygenation system

39

Purge gas absorber unit, carbon dioxide absorber (CO ₂ - Remove) in the oxygenation system

40

Physiological patient monitoring system (PPM)

50

System for imaging and diagnosis of the heart and lungs

60

Gas connection for supplying gases (oxygen, air) to the ventilator

67

Gas mixer for mixing gases (oxygen, air) in the ventilator

68

further absorber unit

70

Heating system for amounts of blood on the oxygenation connection system

75

Humidification / heating system for breathing gas on the breathing gas connection system

100

Reservoir (anesthetic tank) for inhaled substances or anesthetics

101

Dosing element

102

Anesthetic warming

103

Feed line for providing the gas mixture to the switchover unit 8

210

Data lines, data connections, data nodes

211

Data interfaces, data nodes, data coordination (switch, hub, router)

212

Network connection system, data network (LAN, WLAN, Bluetooth, PAN, Ethernet),

213

Components in the data network (database, server, router, access point, hub)

300

Exhaust gas outlet (waste)

1000

System ( 1 )

2000

extended system ( 2 )

3000

extended system ( 3 )

QUOTES INCLUDED IN THE DESCRIPTION

This list of the documents listed by the applicant was generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Patent literature cited

• US 2016067434 AA [0004]
• US 4148312 A [0005]
• US 2016008567 AA [0006]
• WO 09033462 A1 [0007]
• GB 2568813 A1 [0008]
• WO 2009033462 A1 [0009]
• US 2020038564 AA [0010]
• US 9901885 [0011]
• US 6174728 [0012]
• US 4279775 A [0012]
• US 2003064525 AA [0012]

Claims (33)

System (1000) for ventilation and oxygenation of a patient (30), comprising - a ventilator (1) with a ventilation system (1), with a breathing gas connection system (5), and with a connection element (25) close to the patient, - an oxygenation system ( 2) with an oxygenation connection system (6), - a system for inhalative sedation (17) with a dosing system (7), with a gas extraction connection (16), with a reflection unit (18) and a gas return connection (24), - a switching unit (8), - a breathing gas metering path (3), - a flushing gas metering path (4) - at least one control unit (9), the ventilation system (1) having means (27, 60, 67) for providing breathing gases the patient (30), the breathing gas connection system (5) being configured as a gas-carrying connection to a supply with supply and continuation of breathing gases to the patient, the breathing gas connection system (5) being configured to supply a with in partial amount of breathing gas enriched with halative substances is formed from the switching unit (8) via the near-patient connection element (25) to the patient (30), the breathing gas connection system (5) for supplying a further partial amount of breathing gas not enriched with inhalative substances from the ventilation system (1) to the patient (30) via the connecting element (25) close to the patient, the inhalative sedation system (SIS) (17) with the dosing system (7) being designed for dosing inhaled substances (100) , wherein the switching unit (8) is designed to divide and / or distribute gas quantities enriched with inhalative substances (100) in the breathing gas dosing path (3) and the flushing gas dosing path (4), the switching unit (8) being designed , a partial amount of breathing gas enriched with the inhaled substances by means of the breathing gas metering path (3) and by means of the connecting elements close to the patient tes (25) to supply and provide the patient's (30) airways, the switching unit (8) being designed to supply and provide a partial amount of breathing gas enriched with the inhaled substances by means of the flushing gas dosing path (4) to the oxygenation system (2) , wherein the oxygenation system (2) has a membrane (35) for gas exchange with the bloodstream of the patient (30) with a supply of an amount of oxygen and an amount of inhalative and / or volatile substances (100) into the bloodstream of the patient (30) ) and for removing carbon dioxide from the bloodstream of the patient (30), the oxygenation system (2) having means (34, 36, 37) for conveying and / or providing a quantity of the flushing gas to the membrane (35), wherein by means of the oxygenation connection system (6) a supply of the patient (30) with, with volatile substances (100) and with oxygen (O ₂ ) enriched amounts of blood and a continuation guiding of blood quantities enriched with carbon dioxide (CO ₂ ) is made possible, the at least one control unit (9) being designed to control the switching unit (8). System (1000, 2000, 3000) according to Claim 1 , wherein the metering system (7) is designed for metering inhalation and / or volatile substances or volatile anesthetics (100). System (1000, 2000, 3000) according to Claim 1 or Claim 2 , wherein the gas return connection (24), the reflection unit (18) and the connection element (25) close to the patient are designed as one structural unit. System (1000, 2000, 3000) according to one of the Claims 1 until 3 , wherein a filter element (28) is arranged on the reflection unit (18). System (1000, 2000, 3000) according to Claim 4 wherein the filter element (28) is designed as an HME filter for absorbing and releasing moisture or wherein the filter element (28) is designed as a filter for retaining germs, viruses or bacteria in the breathing gas. System (1000, 2000, 3000) according to Claim 4 or Claim 5 , wherein the gas extraction connection (16), the gas return connection (24) in a common structural unit with the reflection unit (18) and / or and / or the breathing gas connection system (5) and / or the connection element (25) close to the patient and / or the filter element (28) are formed. System (1000, 2000, 3000) according to Claim 4 or Claim 5 , wherein the gas extraction connection (16) and the gas return connection (24) are formed in a common structural unit with the reflection unit (18) and / or an expiration valve close to the patient and / or the breathing gas connection system (5) and / or the connection element (25) close to the patient and / or the filter element (28). System (1000, 2000, 3000) according to one of the preceding claims, wherein the control unit (9) is designed to dose the inhaled substances on the basis of the connection element (25) close to the patient, the breathing gas connection system (5) or the reflection unit ( 18) to control certain concentrations of inhaled substances. System (1000, 2000, 3000) according to Claim 8 , the control unit (9) being designed to control the dosage of the inhaled substances on the basis of an end-tidal concentration of at least one inhaled substance or at least one anesthetic. System (1000, 2000, 3000) according to one of the preceding claims, wherein the dosing system (7) as a component - the inhalative sedation system (SIS) (17), - the ventilator (1) or ventilation system (1), - the breathing gas connection system (5) is trained. System (1000, 2000, 3000) according to one of the preceding claims, wherein the switching unit (8) as a component - the inhalative sedation system (SIS) (17), - the ventilator (1) or ventilation system (1), - the breathing gas connection system (5), - the oxygenation connection system (6), - the breathing gas dosing path (3), - the purging gas metering path (4), - the dosing system (7) is trained. System (1000, 2000, 3000) according to one of the preceding claims, wherein a blood delivery unit (36) for transporting amounts of blood to the patient (30) and / or from the patient (30) in or on the oxygenation connection system (6) and / or the oxygenation system (2) is arranged. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) for a system (1000, 2000, 3000) for ventilation and oxygenation of a patient (30) formed from a switching unit (8) and a breathing gas metering path (3) , a connection element (25) close to the patient, a gas extraction connection (16) for withdrawing partial amounts of breathing gas from the inhalation gas, a gas return connection (24) for inhalation gas and a flushing gas metering path (4), wherein at least the switching unit (8), the breathing gas Dosing path (3), the connecting element (25) close to the patient, the gas extraction connection (16), the gas return connection (24) form a common structural unit. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 , wherein the gas distribution unit includes the reflection unit (18) and / or the HME filter (28) and / or the further filter element (28) in the common structural unit. System (2000, 3000) according to one of the Claims 1 until 12th , as well as system (2000, 3000) with a gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 or Claim 14 , wherein a gas delivery unit (38) for transporting flushing gas is arranged in the gas splitting unit, in the flushing gas metering path (4) or the oxygenation system (2). System (2000, 3000) according to one of the Claims 1 until 12th or Claim 15 , as well as system (2000, 3000) with a gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 or 14th wherein a purge gas absorber unit (39) for removing carbon dioxide from the purge gas is arranged in the purge gas metering path (4) or the oxygenation system (2). Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 or Claim 14 , as well as system (3000) according to one of the Claims 1 until 12th , as Claims 15 until 16 , wherein in the system (3000) an exhaust line (29) from the ventilation system (1) to the gas distribution unit (3, 7, 8, 9, 18, 24, 25) or to the switching unit (8) is arranged, which feeds Exhaled gases from the ventilation system (1) to a mixing chamber (19) arranged in or on the switchover unit (8) or in or on the gas distribution unit (3, 7, 8, 9, 18, 19, 24, 25) and removal of carbon dioxide from the breathing gas. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 or Claim 14 , as well as system (1000, 2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 17th , wherein the at least one control unit (9, 10, 11, 12, 15) is designed as a central control system or a central control unit. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 or Claim 14 , as well as system (1000, 2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 18th , wherein individual control units (9) form a decentralized control system, with at least one control unit (9, 10) each being arranged in the oxygenation system (2) and in the ventilation system (1). Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 19 , as well as system (1000, 2000, 3000) according to Claim 19 , with a single control unit (9) in the switching unit (8) and / or a single control unit (12) in the dosing system (7) and / or an external control unit (15) being arranged in the decentralized control system, one of the individual Control units (8, 9, 12) and / or the external control unit (15) is designed to control the switching unit (8) and / or the metering system (7). Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 or Claim 14 , as well as system (2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 20th , at least one of the control units (9, 10, 11, 12, 15) taking into account the data provided by the ventilation system (1) and / or the oxygenation system (2) when checking the switching unit (8). Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 or Claim 14 , as well as system (2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 21 , wherein a process gas analysis unit (21) is arranged for an analysis in or on the oxygenation system (2), in or on the oxygenation connection system (4) or is assigned to the oxygenation system (2) in or on the oxygenation connection system (4) and wherein the process gas analysis unit (21) is designed to provide the system (2000, 3000) and / or at least one of the control units (9, 10, 11, 12, 15) with certain data on the basis of the analysis. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 or Claim 14 , as well as system (2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 22nd , wherein a process gas analysis unit (23) for analysis is arranged in or on the connection element (25) close to the patient or with the gas distribution unit (3, 7, 8, 9, 18, 24, 25) or the connection element (25) close to the patient by means of a measurement gas line ( 26) is connected, is arranged in or on the inhalative sedation system (SIS) (17) or is assigned to the inhalative sedation system (SIS) (17) and the process gas analysis unit (23) is designed to be the inhalative sedation system ( SIS) (17), the system (2000, 3000) and / or at least one of the control units (9, 10, 11, 12, 15) to provide certain data on the basis of the analysis. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 23 , as well as system (2000, 3000) according to Claim 23 , wherein a central process gas analysis unit is arranged in the system (1000, 2000, 3000) or is assigned to the system (2000, 3000), the central process gas analysis unit being designed together with a switching and distribution control unit, analyzes of gas samples from the system for inhalative sedation (SIS) (17), the breathing gas connection system (5), the connection element close to the patient (25), the oxygenation system (2), the oxygenation connection system (4), the dosing system (7) or the switching unit (8) and system (2000, 3000) and / or at least one of the control units (9, 10, 11, 12, 15) to provide certain data on the basis of the analyzes. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 23 or Claim 24 , as well as or system (2000, 3000) according to Claim 23 or Claim 24 , wherein a blood gas analysis unit (22) is arranged for an analysis in or on the oxygenation system (2) or the oxygenation connection system (4) or is assigned to the oxygenation system (2) or the oxygenation connection system (4) and wherein the blood gas analysis unit (22 ) is designed to provide the oxygenation system (2), the system (2000, 3000) and / or at least one of the control units (9, 10, 11, 12, 15) with certain data on the basis of the analysis. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 23 until Claim 25 , as well as system (2000, 3000) according to Claim 23 until Claim 25 , wherein a process gas analysis unit (23) is arranged or assigned to an analysis in or on the switchover unit (8) or the dosing system (7) and the process gas analysis unit (23) is designed, the switchover unit (8), the dosing system (7), to provide certain data to the system (2000, 3000) and / or at least one of the control units (9, 10, 11, 12, 15) on the basis of the analysis Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 until 26th , as well as system (2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 26th , wherein in or on the gas distribution unit (68), in or on the switching unit (8), in or on the connection element (25) close to the patient, in / or on the breathing gas connection system (5) a humidification / heating system (75) for Breathing gas is arranged to heat breathing gases. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 until 27 , as well as system (1000, 2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 27 , wherein a data network (212) is arranged in or on the system (1000, 2000, 3000) or is assigned to the system (1000, 2000, 3000), the data network (212) being designed to store data in the system (1000, 2000, 3000), the control unit (9) or the individual control units (9, 10, 11, 12, 15), the blood gas analysis unit (22), the process gas analysis units (20, 21, 23), the ventilation system (1), the oxygenation system (2), the switching unit (8), the dosing system (7), the inhalative sedation system (SIS) (17) or other components and thus the control unit (9), the control unit of the dosing system (7) or the individual control units (9, 10, 11, 12, 15) in the system (1000, 2000, 3000) to enable the switching unit (8) and / or the dosing unit (7) to be monitored and / or coordinated. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 until 28 , as well as system (2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 28 wherein a system (40) for physiological patient monitoring (PPM) is arranged in or on the system (2000, 3000) or a system (40) for physiological patient monitoring (PPM) is arranged in the system (1000, 2000, 3000) is assigned, the system (40) being designed for physiological patient monitoring (PPM), the system (2000, 3000), the ventilation system (1), the oxygenation system (2), the dosing system (7) or the switching unit (8 ), and / or to provide data to at least one of the control units (9, 10, 11, 12, 13, 15) or the data network (212). Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 until 29 , as well as system (2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 29 wherein a system (50) for imaging and diagnosis of the heart and lungs is arranged in or on the system (2000, 3000) or a system (50) for imaging and diagnosis of heart and lungs is arranged in the system (1000, 2000, 3000) is assigned, the system (50) being designed for imaging and diagnosis of the heart and lungs, the system (2000, 3000), the ventilation system (1), the oxygenation system (2), the dosing system (7), the switching unit (8 ) or the system for physiological patient monitoring (PPM) and / or at least one of the control units (9, 10, 11, 12, 15) or the data network (212) to provide data. Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 until 30th , as well as system (1000, 2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 30th , wherein the system (2000, 3000) is designed to provide data with the data network (212) in a data exchange (210, 211, 212, 213). Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 until 31 , as well as system (1000, 2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 31 , the control unit (9) being formed in the dosing system (7) as a function of the data provided in the data network (212) and / or as a function of the data provided by one of the control units (9, 10, 11, 12, 15) control the amount of inhaled substances (100). Gas distribution unit (3, 7, 8, 9, 18, 24, 25) according to Claim 13 until 32 , as well as system (2000, 3000) according to one of the Claims 1 until 12th , as Claims 15 until 32 , the control unit (9) being embodied in the switchover unit (8) depending on the data provided in the data network (212) and / or depending on the data provided by one of the control units (9, 10, 11, 12, 15) Data on the distribution and / or division of the amount of inhalative substances (100) in the flushing gas metering path (4) to the oxygenation system (2) and the breathing gas metering path (3) to the connecting element (25) close to the patient or to the reflection unit (18).

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